| NPI | 1316028111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111N00000X Chiropractor (Licence: WV 293) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: PA DC-1813-L) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2012-01-13 |